Asteatotic Eczema (Eczema Craquelé or Xerotic Eczema)

What is asteatotic eczema?

Asteatotic eczema (pronounced “uh-stee-toh-tick” “eg-zuh-muh”) is a type of eczema that causes patches of dry, itchy and cracked skin. This condition is most common in the winter, when the air is dry and you use heat to warm your body.

Asteatotic eczema causes patches of your skin to dry out. Similar to how a mud puddle dries out when exposed to heat and sunlight, your skin cracks from a lack of moisture.

Cracks in your skin can turn into sores, especially if you scratch them. This puts you at risk of developing an infection. Moisturizing your skin with ointments or skin creams helps treat asteatotic eczema.

Asteatotic eczema is also known as xerotic eczema or eczema craquelé.

How common is asteatotic eczema?

Asteatotic eczema is one of the most common types of eczema. It’s the most frequent type among people 60 years of age or older.

What are the symptoms of asteatotic eczema?

Symptoms of asteatotic eczema include:

• Dry, scaly, bumpy patches of skin.
• Itchy skin.
• Skin discoloration (red to purple tones or darker than your natural tone).
• Cracked skin (fissures).

Severe asteatotic eczema happens when you develop deep cracks that turn into sores on your skin. Your skin may swell, hurt and drain pus. Contact a healthcare provider right away if you notice these symptoms, as they’re a sign of an infection.

Where do symptoms of asteatotic eczema affect my body?

Asteatotic eczema flare-ups can affect any part of the skin on your body. The most common locations include on your:

• Ears.
• Face.
• Hands and arms.
• Legs and shins.
• Torso.

What causes asteatotic eczema?

Dehydration or water loss from the outermost layer of your skin (epidermis) causes asteatotic eczema.

The condition most often affects people after age 60 because glands in your skin produce less sweat and oil as you age. Sweat and oil form a protective barrier to keep your skin hydrated.

What are the risk factors for asteatotic eczema?

You may be more at risk of developing a flare of asteatotic eczema if you:

• Live in a cold, dry climate.
• Expose your skin to heat, like sitting in front of a fireplace.
• Take long, hot baths or showers.
• Use harsh soaps.
• Wear clothing that rubs against your skin (friction).

Certain conditions, like hypothyroidism or medications like diuretics, may increase your skin’s risk of drying out.

Asteatotic eczema may also run in your biological family history, so you’re more likely to develop it if a relative also has it.

Is asteatotic eczema contagious?

No, asteatotic eczema isn’t contagious. The condition doesn’t spread through person-to-person contact.

How is asteatotic eczema diagnosed?

Your provider will diagnose asteatotic eczema after a physical examination. They’ll learn more about your medical history and symptoms during this exam.

The physical appearance of your symptoms usually leads to a diagnosis, and additional tests aren’t necessary. If your provider offers a test, it could diagnose the underlying cause of your symptoms. For example, if they suspect your symptoms are the result of hypothyroidism, your provider will offer a thyroid function blood test.

How do you treat asteatotic eczema?

Treatment for asteatotic eczema focuses on rehydrating your skin. The first line of treatment is using a moisturizer (skin cream or ointment). You can apply moisturizer to your skin daily, after taking a shower or bath (when your skin is still damp) or as needed throughout the day.

Depending on the severity of your condition, your provider might recommend using prescription creams or ointments to soothe your skin and help it heal. These could include:

• Topical steroids like hydrocortisone or desonide.
• Topical corticosteroids like fluocinolone, triamcinolone or betamethasone.
• Topical anti-itch creams like pimecrolimus.

You should use moisturizers and topical creams or ointments prescribed by your provider at the same time. Talk to your provider about when to apply each type of moisturizer or cream to your skin. Some creams work best if you apply them to your skin first.

What is the best cream for asteatotic eczema?

The best at-home creams or ointments for asteatotic eczema are greasy moisturizers with high oil content. You can purchase these over-the-counter at most retailers. Look for “healing” creams or ointments.

Avoid using lotions that have water as their main ingredient or are scented. These types of moisturizers can dry out your skin.

How soon after treatment will I feel better?

It can take a couple of weeks for your skin to rehydrate and heal. During this time, make sure you follow your healthcare provider’s instructions so you’re healing as expected.

How can I reduce my risk of asteatotic eczema?

You can reduce your risk of developing a flare-up of asteatotic eczema symptoms by:

• Taking shorter baths or showers (no more than 15 minutes) with warm, not hot, water.
• Keeping a distance between yourself and your heating source in the winter, especially a fireplace or a radiator.
• Using a moisturizer after a bath or shower and throughout the day.
• Using gentle cleansers instead of harsh soaps.
• Using a humidifier in your home.

What can I expect if I have asteatotic eczema?

Asteatotic eczema is a chronic condition that can go away and come back unexpectedly. There’s no cure for the condition, but treatment helps your skin heal. You can prevent flare-ups (the return of symptoms) by keeping your skin hydrated and using moisturizer daily.

Eczema prevents your skin’s protective barrier from working as expected, which can make you more at risk of developing an infection in the cracks in your skin. While you have a flare of symptoms, try to avoid scratching your skin. Scratching your skin can break open the cracks to create a wound. Resisting scratching can be very difficult to do, but you can use an over-the-counter anti-itch cream to help prevent itchiness.

When should I see my healthcare provider?

Visit your healthcare provider if you have symptoms of asteatotic eczema that don’t get better using at-home moisturizers.

Contact your provider immediately if your cracked skin becomes infected. Symptoms of an infection include:

• Pain.
• Swelling.
• Fluid or pus leaking out of skin bumps or sores.
• Fever and chills.

What questions should I ask my healthcare provider?

• What type of moisturizer do you recommend?
• How often should I apply prescription creams to my skin?
• Should I apply moisturizer or a prescription treatment to my skin first?
• Are there side effects to the treatment?